COLUMBIA  LIBRARIES  OFFSITE 

HEALTH  SCIENCES  STANDARD 


HX64153819 
RC261  .H6718         Some  essential  stati 


RECAP 


SOME  ESSENTIAL  STATISTICS 
OF 
CA1ICER  MORTALITY     - 


BY 
HOFFMAN 


RC.26/ 


Hb7/6 


Columbia  (Hnitier^ttp 

College  of  ^fjpsicianfi  ano  ££>urgeon£ 
ILibv&vp 


Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/someessentialstaOOhoff 


Some  Essential  Statistics  of  Cancer 

Mortality  Throughout 

the  World 


By 

FREDERICK  L.  HOFFMAN,  LL.D.,  F.S.S.,  F.A.S.A. 

NEWARK,  N.  J. 


PUBLICATIONS  OF  THE 
AMERICAN  SOCIETY  FOR  THE  CONTROL  OF  CANCER 

105  EAST  22ND  STREET,  NEW  YORK 

Bulletin    8  December,    1915 


SOME    ESSENTIAL    STATISTICS    OF 
CANCER    MORTALITY    THROUGH- 
OUT   THE    WORLD 


By 

FREDERICK    L.    HOFFMAN 

Chairman,  Committee  on  Statistics,  American  Society  for  the  Control  of  Cancer 


This  reprint  is  a  part  of  the  Commemoration  Volume,  issued  by  the  American 
Medical  Association  at  its  meeting  in  San  Francisco,  June  22  to  26,  1915,  as  c 
tribute  to  the  medical  sciences,  which  made  possible  the  building  of  the  Panamc 
Canal  and  the  Panama  Pacific  Exposition. 


TZCUl 


Copyright,   1915 

BY    THE 

American  Medical  Association 


SOME    ESSENTIAL     STATISTICS     OF     CANCER    MOR- 
TALITY   THROUGHOUT    THE    WORLD 


In  the  furtherance  of  international  cancer  studies,  it  is  obvious 
that  the  first  prerequisite  is  trustworthy  and  comparable  cancer  mor- 
tality statistics.  In  course  of  time  cancer  morbidity  data  should  become 
available  through  the  cooperation  of  large  hospitals  and  special  insti- 
tutions for  the  treatment  of  cancer  patients.  An  additional  source  of 
information  should  be  the  consolidated  experience  data  of  American 
and  foreign  life  insurance  companies.  The  amount  of  existing  statis- 
tical information  on  the  subject  of  cancer  is  truly  enormous.  In  a 
forthcoming  work  on  The  Mortality  from  Cancer  Throughout  the 
World,  I  have  made  an  earnest  effort  to  bring  together  in  a  comparable 
form  the  information  most  likely  to  be  useful  in  the  furtherance  of 
cancer  research,  so  far  as  the  statistical  data  can  be  of  value  in  this 
direction. 

Aside  from  the  scientific  necessities  of  the  existing  situation,  the 
statistical  data  are  useful  in  advancing  the  nation-wide  effort  at  cancer 
control  through  the  required  education  of  the  medical  profession  and 
the  laity  as  regards  the  menace  of  cancer  and  the  urgency  of  improved 
methods  of  early  diagnosis  and  of  more  qualified  medical  or  surgical 
treatment  of  cancer  in  the  early  stages  of  the  disease.  It  would  serve 
no  purpose  to  restate  on  this  occasion  the  rather  extended  argument 
advanced  in  behalf  of  the  utility  of  the  statistical  method  in  the  study 
of  the  cancer  problem  in  the  work  referred  to,  and  it  has  therefore 
seemed  better  to  limit  the  present  discussion  to  a  brief  restatement  of 
the  salient  facts  of  the  worldwide  study  of  the  cancer  problem  on  the 
basis  of  at  least  reasonably  trustworthy  and,  in  practically  every  case, 
official  mortality  returns. 

It  may  not  be  out  of  place,  however,  briefly  to  refer  to  the  often 
repeated  argument,  that  on  account  of  inherent  difficulties  of  exact 
diagnoses,  the  returns,  particularly  for  earlier  periods,  are  intrinsically 
untrustworthy  and  therefore  not  strictly  comparable  with  the  statistics 
of  the  present  day.  Nevertheless  it  has  properly  been  pointed  out  by 
the  late  Mitchell  Banks  that,  "while  the  diagnosis  of  cancer  is  prob- 
ably made  much  more  frequently  now  than  in  former  times,  it 
required  little  skill  to  make  the  diagnosis  at  the  time  of  the  death  of 
the  patient.  The  diagnosis  at  such  a  time  was  by  no  means  beyond 
the  ability  of  even  the  rural  practitioner  of  fifty  years  ago."  The  argu- 


4  CANCER    STATISTICS— HOFFMAN 

ment  derived  exclusively  from  necropsy  records,  that  the  clinical  diag- 
nosis of  cancer  is  often  at  variance  with  the  facts,  is  in  all  probability 
decidedly  overdrawn.  Discrepancies  between  the  clinical  and  anatomic 
diagnoses  are  much  more  common,  in  any  event,  in  the  case  of  many 
other  important  diseases  than  in  that  of  cancer;  and  the  evidence  has 
not  been  forthcoming  that  in  any  considerable  number  of  cases  cancer 
deaths  have  been  erroneously  diagnosed  as  due  to  other  causes,  more  or 
less  allied  with  malignant  disease.  There  exists  a  confusion  of  thought, 
caused  in  part  by  the  misconception  that  the  terminal  diagnosis  of  can- 
cer which  underlies  the  certificate  of  death,  is  assumed  to  be  identical 
with  the  initial  diagnosis  of  the  disease,  which,  it  hardly  requires  to  be 
said,  ever  has  been  and  ever  is  likely  to  be  a  most  difficult  problem  con- 
fronting the  physician  at  the  bedside.  On  the  basis  of  what  is  probably 
the  most  comprehensive  statistical  study  ever  made  of  a  single  disease 
in  the  history  of  medicine,  I  feel  absolutely  confident  that  the  returns 
regarding  the  mortality  from  cancer  are,  in  the  main,  trustworthy  and 
strictly  comparable  for  a  considerable  period  of  time. 

Subject  to  the  foregoing  observations,  the  accompanying  tables  are 
presented,  with  the  further  explanation  that  the -required  amplification 
of  the  data  and  the  discussion  of  the  problems  resulting  therefrom  are 
made  conveniently  accessible  in  the  work  previously  referred  to,  which 
will  be  printed  for  gratuitous  distribution  in  behalf  of  the  cancer  cause, 
by  the  Prudential  Insurance  Company  of  America. 

Table  1  indicates  the  approximate  cancer  death  rate  of  the  different 
continents  and  for  the  world  at  large,  for  the  five  years  ending  with 
1912: 

TABLE    1.— MORTALITY    FROM    CANCER,    REGISTRATION    COUNTRIES    OF    THE 
WORLD,    PERIOD    1908-1912 

Total 
Continent  Population 

Africa    9,041.866 

America     382,293,573 

Asia    272,814,962 

Australia     27,939,842 

Europe    1,425,516,942 


Deaths 

Rate  per  100,000 

rom  Cancer 

Population 

3,018 

33.4 

251,535 

65.8 

148,447 

54.4 

20,276 

72.6 

1,082,704 

76.0 

Total    2,117,607,185  1,505,980  71.1 

Table  1  is  based  on  a  total  population  of  civilized  countries,  about 
440,000,000,  or  about  25  per  cent,  of  the  entire  population  of  the 
world,  estimated  for  the  year  1911. 

The  statistics  for  the  principal  European  countries  are  given  in 
Table  2,  for  the  period  1896-1910,  to  facilitate  the  convenient  com- 
parison of  the  rate  for  three  quinquennial  periods. 


CANCER    STATISTICS— EUROPEAN  5 

TABLE    2.— MORTALITY    FROM    CANCER    IN    EUROPEAN    COUNTRIES,    PERIOD 

1896-1910 

, Rates  per  100,000  Population — ^ 

Country                                                  1896-1900         1901-1905  1906-1910 

England  and  Wales 80.1  86.7  94.0 

Scotland    77.1  84.8  99.7 

Ireland    58.1  68.5  78.8 

Norway    85.7  94.9  96.6 

Denmark*    118.9  129.1  137.3 

German  Empire 70.8  77.7  84.2 

Holland    91.9  97.8  103.5 

Switzerland   127.4  128.3  125.9 

Austria 68.9  74.7  78.3 

Hungary    30.7  39.1  43.6 

Italy    50.9  55.2  63.6 

France*    97.3  92.1  102.7 

All    countries 69.1  74.2  81.0 

*  Cities  only. 

According  to  this  table,  the  European  cancer  death  rate  has 
increased  from  69.1  during  the  first  five  years  to  74.2  during  the  second, 
and  finally  to  81.0  during  the  third. 

The  geographic  distribution  of  cancer  according  to  latitude  for  130 
of  the  world's  largest  cities,  also  for  the  period  1908-1912,  is  shown 
in  Table  3. 

TABLE   3.— MORTALITY  FROM   CANCER   IN  CITIES   ACCORDING  TO   LATITUDE, 


Jf  JlKlUiJ 

lyus-iyiz 

Rate  per 

No.  of 

Degrees  of 

Population 

Aggregate 

Deaths  from 

100,000 

Cities 

Latitude 

1912 

Population 

Cancer 

Population 

35 

50  N.-70  N. 

23,980,086 

112,912,675 

119,374 

105.7 

48 

40  N.-50  N. 

27,519,705 

131,256.257 

121,216 

92.4 

24 

30  N.-40  N. 

10,195,197 

47,944,253 

37,451 

78.1 

7 

10  N.-30  N. 

2,780,447 

13,476,168 

5,696 

42.3 

4 

10  S.-10  N. 

559,630 

2,583,495 

1,056 

40.9 

7 

10  S.-30  S. 

1,806,951 

8,066,144 

3,040 

37.7 

5 

30  S.-40  S. 

2,678,287 
69,520,303 

12,297,218 
328,536,210 

11,048 

89.8 

130 

298,881 

91.0 

It  is  shown  by  Table  3  that  the  average  cancer  death  rate  for  130 
cities  was  91.0  per  100,000  of  population;  that  the  rate  was  highest  in 
the  most  northerly  inhabited  latitudes,  or  that  section  of  the  globe 
which  is  comprehended  between  50  and  70  degrees  north  latitude,  and 
that  for  this  section  the  rate  was  105.7  diminishing  to  92.4  for  the 
cities  located  between  40  and  50  degrees,  to  78.1  for  cities  between  30 
and  40  degrees,  to  42.3  for  cities  between  10  and  30  degrees,  to  40.9 
for  cities  between  10  degrees  north  latitude  and  10  degrees  south  lati- 
tude, and  finally,  to  37.7  for  cities  between  10  and  30  degrees  south 
latitude.  In  the  most  southerly  inhabited  belt,  between  30  and  40 
degrees  south  latitude,  the  cancer  death  rate  again  rose  to  89.8,  which 
is  practically  equivalent  to  the  rate  for  30  to  50  degrees  north  latitude. 
Table  3,  therefore,  would  seem  to  warrant  the  important  conclusion 
that  cancer  frequency  is  to  a  limited  extent  determined  by  latitude, 
which,  of  course,  more  or  less  represents  the  factor  of  climate  and 


6  CANCER    STATISTICS— HOFFMAN 

weather  .conditions ;  in  other  words,  cancer  is  excessively  common  in 
the  temperate  zone,  moderately  common  in  the  medium  zone  and  rela- 
tively rare  in  the  torrid  or  semitorrid  zone,  which  for  the  present  pur- 
pose may  be  construed  to  include  the  belt  between  latitude  30  north  and 
latitude  30  south. 

The  possible  relation  of  cancer  mortality  to  the  size  of  cities  is  of 
some  importance  in  view  of  the  unquestionable  effect  of  the  admission 
of  non-residents  to  hospital  treatment  and  the  non-correction  of  the 
death  rates  by  the  redistribution  of  deaths  according  to  the  residence 
of  the  deceased.  In  the  case  of  small  cities  with  exceptional  hospital 
facilities  this  factor,  no  doubt,  is  of  considerable  weight,  but  in  the 
case  of  large  cities,  the  influence  is  relatively  slight. 

TABLE    4. —  MORTALITY    FROM    CANCER    IN    CITIES,    ACCORDING    TO     SIZE, 


No.  of 
Cities 

14 

67 

49 

Size 

1,000,000    and    over 
250,000   to   1,000,000 
Less    than    250,000 

PERIOD     190 

Population 

1912 

30,872,254 

31,907,716 

6,740,333 

69,520,303 

3-1912 

Aggregate 
Population 
147,889,255 
148,806,139 
31,840.816 

Deaths 
from 
Cancer 
137,531 
133,286 
28,064 

298,881 

Rate  per 

100,000 

Population 

93.0 

89.6 

88.1 

130 

328,536,210 

91.0 

The  cancer  mortality  statistics  for  the  United  States  are  limited 
to  the  registration  area,  which  in  1913  comprehended  about  65  per  cent, 
of  the  total  population.  Table  5  shows  first  the  estimated  mortality 
from  cancer  in  the  continental  United  States,  and  second  the  actual 
mortality  as  reported  for  the  registration  area.  The  rates  returned  for 
the  latter  have  been  applied  to  the  population  estimates  of  the  former 

TABLE   5.— ESTIMATED  MORTALITY  FROM  CANCER  IN  CONTINENTAL  UNITED 

STATES    AND   ACTUAL    MORTALITY   FROM   CANCER   IN  UNITED 

STATES    REGISTRATION    AREA,    PERIOD    1900-1913 


Est.  No. 

Population 

Cancer  Death  Rate 

Deaths 

Population 

Deaths 

Rate  per 

Continental 

per  100,000,  U.  S. 
Registration  Area 

from 

United  States 

from 

100,000 

Year 

United  States 

Cancer 

Reg.  Area 

Cancer 

Population 

1900 

75,994,575 

62.9 

47,829 

30,794,273 

19,381 

62.9 

1901 

77,592,344 

64.3 

49,890 

31,370,952 

20,171 

64.3 

1902 

79,190,113 

65.1 

51,542 

32,029,815 

20,847 

65.1 

1903 

80,787,882 

68.3 

55,153 

32,701,083 

22,325 

68.3 

1904 

82,385,651 

70.2 

57,794 

33,349,137 

23,395 

70.2 

1905 

83,983,420 

71.4 

59,931 

34,094,605 

24,330 

71.4 

1906 

85,581,189 

69.1 

59,155 

41,983,419 

29,020 

69.1 

1907 

87,178,958 

70.9 

61,840 

43,016,990 

30,514 

70.9 

1908 

88,776,727 

71.5 

63,494 

46,789,913 

33,465 

71.5 

1909 

90,374,496 

73.8 

66,731 

50,870,518 

37,562 

73.8 

1910 

91,972,266 

76.2 

70,099 

53,843,896 

41,039 

76.2 

1911 

93,570,036 

74.3 

69,494 

59,275,977 

44,024 

74.3 

1912 

95,167,806 

77.0 

73,282 

60,427,247 

46,531 

77.0 

1913 

96,765,576 

78.9 

76,319 

63,298,718 

49,928 

78.9 

For  the  year  1914  it  would  seem  an  entirely  safe  assumption  that 
the  aggregate  mortality  from  cancer  approaches,  if  it  does  not  exceed, 
79,000. 


CANCER    STATISTICS— UNITED    STATES  7 

The  comparative  mortality  of  males  and  females  from  cancer  in 
the  United  States  registration  area  for  the  period  1900-1913,  is  shown 
in  Table  6. 


TABLE 


6.— MORTALITY    FROM    CANCER,    ALL    ORGANS    AND    PARTS,    BY    SEX, 
UNITED    STATES    REGISTRATION    AREA,    PERIOD    1900-1913 


r 

-Males 

Deaths 

Rate  per 

r 

—Females — 
Deaths 

^ 

Rate  per 

Year 

Population 

from 

100,000 

Population 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

1900 

15,415,757 

7,294 

47.3 

15,378,516 

12,087 

78.6 

1901 

15,742,434 

7,706 

49.0 

15,628,518 

12,465 

79.8 

1902 

16,111,848 

7,798 

48.4 

15,917,967 

13,049 

82.0 

1903 

16,489,113 

8,422 

51.1 

16,211,970 

13,903 

85.8 

1904 

16,856,270 

8,881 

52.7 

16,492,867 

14,514 

88.0 

1905 

17,274,352 

9,189 

53.2 

16,820,253 

15,141 

90.0 

1906 

21,322,133 

11,166 

52.4 

20,661,286 

17,854 

86.4 

1907 

21,899,144 

11,800 

53.9 

21,117,846 

18,714 

88.6 

1908 

23,876,529 

13,046 

54.6 

22,913,384 

20,419 

89.1 

1909 

26,020,431 

14,913 

57.3 

24,850,087 

22,644 

91.1 

1910 

27,606,526 

16,373 

59.3 

26,237,370 

24,666 

94.0 

1911 

30,463,411 

17,525 

57.5 

28,812,566 

26,499 

92.0 

1912 

31,128,193 

18,464 

59.3 

29,298,940 

28,067 

95.8 

1913 

32,681,358 

20,045 

61.3 

30,617,806 

29,883 

97.6 

During  the  year  1913  it  is  shown  that  the  cancer  death  rate  for 
males  was  61.3  and  the  rate  for  females  was  97.6.  There  was,  there- 
fore, an  actual  excess  in  the  mortality  of  women  of  36.3  per  100,000 
of  population;  or,  in  other  words,  to  every  100  deaths  from  cancer 
among  women,  there  were  only  sixty-three  deaths  from  cancer  among 
men. 

The  cancer  mortality  returns  for  most  countries  are  on  the  basis 
of  the  international  classification  of  causes  of  death,  reduced  to  seven 
groups,  respectively,  buccal  cavity,  stomach  and  liver,  peritoneum  and 
intestines  and  rectum,  female  generative  organs,  female  breast,  skin, 
and  other  or  not  specified  organs.  On  account  of  their  special  impor- 
tance, the  statistics  for  the  registration  area  are  given  for  certain 
selected  groups  in  Tables  7,  8  and  9. 


TABLE    7.— MORTALITY    FROM    CANCER    OF    THE    STOMACH    AND    LIVER,    BY 
SEX,    UNITED    STATES    REGISTRATION    AREA,    PERIOD    1900-1913 


^-Males 

and  Females — ^ 

r 

-Males ^ 

females N 

Deaths 

Rate  per 

Deaths 

Rate  per 

Deaths 

Rate  per 

from 

100,000 

from 

100,000 

from 

100,000 

Cancer 

Population 

Cancer 

Population 

Cancer 

Population 

1900 

6,918 

22.5 

3,418 

22.2 

3,500 

22.8 

1901 

7,095 

22.6 

3,594 

22.8 

3,501 

22.4 

1902 

7,483 

23.4 

3,681 

22.8 

3,802 

23.9 

1903 

8,193 

25.1 

4,037 

24.5 

4,156 

25.6 

1904 

8,744 

26.2 

4,340 

25.7 

4,404 

26.7 

1905 

8,939 

26.2 

4,388 

25.4 

4,551 

27.1 

1906 

10,946 

26.1 

5,443 

25.5 

5,503 

26.6 

1907 

11,596 

27.0 

5,779 

26.4 

5,817 

27.5 

1908 

13,044 

27.9 

6,537 

27.4 

6,507 

28.4 

1909 

14,915 

29.3 

7,477 

28.7 

7,438 

29.9 

1910 

16,475 

30.6 

8,135 

29.5 

8,340 

31.8 

1911 

17,365 

29.3 

8,698 

28.6 

8,667 

30.1 

1912 

18.517 

30.6 

9,215 

29.6 

9,302 

31.7 

1913 

19,767 

31.2 

9,749 

29.8 

10,018 

32.7 

CANCER    STATISTICS— HOFFMAN 


TABLE  8.— MORTALITY  FROM  CANCER  OF  THE  FEMALE  GENERATIVE  ORGANS 

AND  FEMALE  BREAST,  UNITED   STATES  REGISTRATION 

AREA,    PERIOD    1900-1913 


Year 

1900 
1901 
1902 
1903 
1904 
1905 
1906 
1907 
1908 
1909 
1910 
1911 
1912 
1913 


-Female  Generative 

Rate  per 

iths  100,000 

>m  Total 

icer  Population 

96  8.8 

19  9.3 

33  9.5 

89  10.1 

36  10.3 

37  10.7 

90  9.7 

88  10.2 
50  11.2 
14  11.2 
47  11.4 
07  11.3 

89  11.7 
06  12.2 


c 

-Female  Breast \ 

Rate  per 

Rate  per 

Deaths 

100,000 

100,000 

from 

Total 

Female 

Cancer 

Population 

Population 

1,400 

4.5 

9.1 

1,621 

5.2 

10.4 

1,734 

5.4 

10.9 

1,777 

5.4 

11.0 

2,019 

6.1 

12.2 

1,994 

5.8 

11.9 

2,421 

5.8 

11.7 

2,590 

6.0 

12.3 

3,023 

6.5 

13.2 

3.585 

7.0 

14.4 

3,730 

6.9 

14.2 

4,190 

7.1 

14.5 

4,356 

7.2 

14.9 

4,514 

7.1 

14.7 

TABLE  9.— MORTALITY  FROM  CANCER  OF  THE  SKIN,  BY  SEX,  UNITED  STATES 
REGISTRATION   AREA,  PERIOD   1900-1913 


Year 

1900 
1901 
1902 
1903 
1904 
1905 
1906 
1907 
1908 
1909 
1910 
1911 
1912 
1913 


—Males  and 
Deaths 
from 
Cancer 

602 

683 

688 

752 

758 

818 

984 
1,121 
1,282 
1,492 
1,459 
1,619 
1,743 
1,725 


Females—^ 

Rate  per 

100,000 

Population 

2.0 

2.2 

2.1 

2.3 

2.3 

2.4. 

2.3 

2.6 

2.7 

2.9 

2.7 

2.7 

2.9 

2.7 


t             " 

L11CS                           ■>, 

Deaths 

Rate  per 

from 

100,000 

Cancer 

Population 

392 

2.5 

456 

2.9 

454 

2.8 

484 

2.9 

462 

2.7 

539 

3.1 

656 

3.1 

724 

3.3 

827 

3.5 

988 

3.8 

952 

3.4 

1,011 

3.3 

1,079 

3.5 

1,128 

3.5 

r       ■  -re 

111  cllCS ^ 

Deaths 

Rate  per 

from 

100,000 

Cancer 

Population 

210 

1.4 

227 

1.5 

234 

1.5 

268 

1.7 

296 

1.8 

279 

1.7 

328 

1.6 

397 

1.9 

455 

2.0 

504 

2.0 

507 

1.9 

608 

2.1 

664 

2.3 

597 

1.9 

Cancer  is  largely,  if  not  primarily,  a  function  of  age,  or  more 
accurately,  of  senility  and  presenility.  The  mortality  at  ages  under  35 
is  relatively  small,  and  is  chiefly  due  to  sarcoma,  for  which,  however, 
no  separate  returns  are  required  under  the  international  classification. 

Table  10  exhibits  the  mortality  from  cancer  by  sex  and  age  in 
the  United  States  registration  area,  for  the  period  1903-1912. 


TABLE   10.— MORTALITY   FROM   CANCER   OF   ALL  ORGANS   OR   PARTS,   BY  AGE 
AND   SEX,  UNITED  STATES   REGISTRATION  AREA,   PERIOD    1903-1912 


, Males s 

, Females N 

, Increase , 

Ages 

Deaths 

Rate 

Deaths 

Rate 

or 

at 

from 

per  100,000 

from 

per  100,000 

Decrease 

Death 

Cancer 

Population 

Cancer 

Population 

Actual 

Per  cent 

Under    10 

1,170 

2.5 

984 

2.2 

—  0.3 

12.0 

10-24 

2,028 

3.1 

1,844 

2.8 

—  0.3 

9.7 

25-34 

3,757 

9.0 

7,891 

20.6 

+  H.6 

128.9 

35-44 

10,750 

32.3 

26,779 

89.0 

+  56.7 

175.5 

45-54 

24,431 

105.4 

46,669 

222.9 

+  117.5 

111.5 

55-64 

35,327 

257.4 

50,393 

386.4 

+  129.0 

50.1 

65-74 

33,745 

452.8 

43,010 

565.7 

+  112.9 

24.9 

75  and  over 

18,381 

620.2 

24,601 

734.1 

+  113.9 

18.4 

All  ages  * 

129,784 

55.7 

202,421 

90.6 

+  34.9 

62.7 

45  and  over 

111,884 

236.5 

164,673 

366.4 

+  129.9 

54.9 

Including  unknown  ages. 


CANCER    STATISTICS— BY    AGES  9 

It  is  shown  by  this  table  that,  excepting  ages  under  25,  the  cancer 
death  rate  of  females  actually  and  relatively  exceeds  the  rate  of  males, 
but  the  relative  excess  is  highest  at  ages  35  to  44,  when  the  rate  for 
females  exceeds  the  rate  for  males  by  175.5  per  cent. 

The  question  whether  the  observed  increase  in  cancer  has  affected 
all  ages  or  only  certain  periods  of  life  is  naturally  of  great  importance. 
In  Tables  11  and  12  the  cancer  death  rate  for  males  and  females  for 
the  United  States  registration  area  are  compared  for  the  two  periods, 
1903-1907  and  1908-1912. 


TABLE  11.— MORTALITY  FROM  CANCER  OF  ALL  ORGANS  OR  PARTS,  BY  AGES, 

AMONG    MALES,    UNITED    STATES    REGISTRATION   AREA, 

PERIODS    1903-1907   AND    1908-1912 


, 1903-1907 , 

, 1908-1912 , 

, Increase ^ 

Ages 

Deaths 

Rate 

Deaths 

Rate 

or 

at 

from 

per  100,000 

from 

per  100,000 

Decrease 

Death 

Cancer 

Population 

Cancer 

Population 

Actual         Per  cent. 

Under    10 

455 

2.4 

715 

2.6 

+  0.2             -f-  8.3 

10-24 

840 

3.2 

1,188 

3.1 

—  0.1             —3.1 

25-34 

1,527 

9.0 

2,230 

9.0 

35-44 

4,497 

33.4 

6,253 

31.7 

—  1.7             —5.1 

45-54 

9,509 

103.8 

14,922 

106.5 

+  2.7             +  2.6 

55-64 

13,463 

245.7 

21,864 

265.1 

+  19.4             +  7.9 

65-74 

12,588 

427.4 

21,157 

469.5 

+  42.1              +  9.9 

75  and  over 

6,466 

553.9 

11,915 

663.2 

+  109.3           +  19.7 

All  ages  * 

49,458 

52.7 

80,326 

57.7 

+  5.0             +  9.5 

45  and  over 

42,026 

224.1 

69,858 

244.6 

+  20.5             +  9.1 

*  Including 

unknown  age: 

TABLE  12.— MORTALITY  FROM  CANCER  OF  ALL  ORGANS  OR  PARTS,  BY  AGES, 

AMONG  FEMALES,  UNITED  STATES  REGISTRATION  AREA, 

PERIODS     1903-1907    AND     1908-1912 


, 1903-1907 » 

, 1908-1912 , 

, Increase > 

Ages 

Deaths 

Rate 

Deaths 

Rate 

or 

at 

from 

per  100,000 

from 

per  100,000 

Decrease 

Death 

Cancer 

Population 

Cancer 

Population 

Actual         Per  cent 

Under    10 

381 

2.1 

603 

2.3 

+  0.2             +  9.5 

10-24 

753 

2.8 

1,091 

2.9 

+  0.1              +  3.6 

25-34 

3,302 

20.7 

4,589 

20.4 

—  0.3             —1.4 

35-44 

11,068 

90.2 

15,711 

88.1 

—  2.1             —2.3 

45-54 

18,788 

223.0 

27,881 

222.7 

—  0.3             —0.1 

55-64 

20,196 

378.1 

30,197 

392.1 

+  14.0             +  3.7 

65-74 

16,559 

540.9 

26,451 

582.5 

+  41.6             +  7-7 

75  and  over 

8,916 

667.0 

15,685 

778.6 

+  111.6           +  16.7 

All  ages  * 

80,126 

S.7.7 

122,295 

92.6 

+  4.8             +  5.5 

45  and  over 

64,459 

354.9 

100,214 

374.3 

+  19.4             +  5.5 

*  Including 

unknown  ages 

The  results  of  the  comparison  are  extremely  interesting  and  of 
exceptional  practical  utility. 

The  increase  in  cancer  mortality  has  naturally  varied  considerably 
according  to  the  organs  and  parts  of  the  body  affected.  It  would 
carry  me  too  far  to  discuss  these  important  aspects  of  the  cancer  prob- 
lem in  detail,  but  for  the  purpose  of  emphasizing  the  importance  of 
special  cancer  studies,  Tables  13  and  14,  showing  occurrence  of  cancer 
of  the  female  generative  organs  and  of  the  female  breast,  are  included. 


10 


CANCER    STATISTICS— HOFFMAN 


TABLE     13.  — MORTALITY     FROM     CANCER     OF     THE     FEMALE     GENERATIVE 

ORGANS,    UNITED    STATES    REGISTRATION    AREA, 

PERIODS     1903-1907    AND    1908-1912 


Ages 

, 1903-1907 » 

Deaths          Rate 

, 1908-1912 s 

Deaths           Rate 

,. Increase i 

or 

at 

from 

per  100,000 

from 

per  100,000 

Decrease 

Death 

Cancer 

Population 

Cancer 

Population 

Actual         Per  cent. 

Under    10 

8 

0.0 

23 

0.1 

+  0.1         +  125.0 

10-24 

134 

0.5 

236 

0.6 

+  0.1           +  20.0 

25-34 

1,158 

7.3 

1,831 

8.2 

+  0.9           +  12.3 

35-44 

3,836 

31.3 

5,984 

33.6 

+  2.3             +  7.3 

45-54 

5,810 

69.0 

9,090 

72.6 

+  3.6             -f-  5.2 

55-64 

4,529 

84.8 

7,391 

96.0 

+  11.2           +  13.2 

65-74 

2,440 

79.7 

4,463 

98.3 

+  18.6           +  23.3 

75  and  over 

886 

66.3 

1,870 

92.8 

+  26.5           +  40.0 

All  ages  * 

18,840 

20.6 

30,907 

23.4 

-f-  2.8           +  13.6 

45  and  over 

13,665 

75.3 

22,814 

85.2 

+  9.9           +  13.1 

*  Including  unknown  ages. 

TABLE    14.— MORTALITY    FROM    CANCER    OF    THE    FEMALE    BREAST,    UNITED 
STATES   REGISTRATION  AREA,  PERIODS   1903-1907  AND    1908-1912 


Ages 

, 1903-1907 , 

Deaths          Rate 

, 1908-1912 s 

Deaths           Rate 

, Ii 

lcrease ., 

or 

at 

from 

per  100,000 

from 

per  100,000 

D 

^crease 

Death 

Cancer 

Population 

Cancer 

Population 

Actual 

Per  cent. 

Under    10 

8 

0.0 

10-24 

15 

0.1 

34 

0.1 

25-34 

343 

2.2 

575 

2.6 

+  0.4 

+  18.2 

35-44 

1,683 

13.7 

2,900 

16.3 

+  2.6 

+  19.0 

45-54 

2,667 

31.6 

4,861 

38.8 

+  7.2 

-f-  22.8 

55-64 

2,684 

50.3 

4,362 

56.6 

+  6.3 

+  12.5 

65-74 

2,061 

67.3 

3,622 

79.8 

+  12.5 

+  18.6 

75  and  over 

1,330 

99.5 

2,506 

124.4 

+  24.9 

+  25.0 

All  ages  * 

10,801 

11.8 

18,884 

14.3 

+  2.5 

+  21.2 

45  and  over 

8,745 

48.1 

13,351 

57.3 

+  9.2 

+  19.1 

Including  unknown  ages. 


The  estimated  total  mortality  from  cancer  by  organs  and  parts  of 
the  body  in  the  continental  United  States  for  the  year  1913,  on  the 
basis  of  an  aggregate  mortality  of  73,279,  is  shown  in  Table  15. 


TABLE   15.— ESTIMATED  TOTAL  MORTALITY  FROM   CANCER,  BY  ORGANS  AND 
PARTS,     IN    CONTINENTAL    UNITED     STATES,     1913. 

Rate  Number  Percentage 

per  100,000                 of  of 

Population  Deaths  Distribution 

Buccal  cavity    3.11                      3,007  3.94 

Stomach   and   liver 31.23  30,215  39.59 

Peritoneum,   intestines   and   rectum 10.47  10,128  13.27 

Female  generative  organs 12.17  11,776  15.43 

Female   breast 7.25                      7,021  9.20 

Skin    2.73                      2,633  3.45 

Other   organs   or   parts 11.92  11,539  15.12 

All  organs  and  parts 78.88  76,319  100.00 


Important  variations  are  found  in  the  cancer  death  rates  according 
to  organs  and  parts  of  the  body,  and  for  the  purpose  of  illustration, 
the  cancer  mortality  for  the  cities  of  Boston  and  San  Francisco  is 
shown  in  Tables  16  and  17. 


CANCER    STATISTICS— BY    LOCALITY 


11 


TABLE   16.— MORTALITY  FROM   CANCER   IN   BOSTON,   MASS.,  BY  ORGANS   AND 
PARTS,    ACCORDING    TO    SEX,    1903-1912 

, — Male  and  Female — ,,    , Male ^      , Female ,, 

Deaths     Rate  per  Deaths     Rate  per  Deaths      Rate  per 

from         100,000  from         100,000  from          100,000 

Organ  or  Part                     Cancer  Population  Cancer  Population  Cancer    Population 

Buccal    cavity 30S             4.9  248           8.0  60             1.9 

Stomach  and  liver 2,027           31.9  918         29.5  1,109           34.2 

Peritoneum,  intestines  and  rectum.      1,127           17.7  446         14.3  681           21.0 

Female  generative   organs 921           14.5  921           28.4 

Breast   657           10.3  7           0.2  650           20.1 

Skin 82             1.3  44           1.4  38             1.2 

Other  or  not  specified  organs 1,318           20.7  679         21.8  639           19.7 

All   organs  and   parts 6,440         101.3  2,342         75.2  4,098         126.5 

TABLE  17.— MORTALITY  FROM  CANCER  IN  SAN  FRANCISCO,  CAL.,  BY  ORGANS 

AND    PARTS,    ACCORDING    TO    SEX,    FROM    JULY    1,  1906, 

TO    JUNE     30,    1913 

r- Male  and  Female—^    , Male N      q Female ^ 

Deaths     Rate  per  Deaths     Rate  per  Deaths      Rate  per 

from         100,000  from         100,000  from          100,000 

Organ  or  Part                     Cancer  Population  Cancer  Population  Cancer    Population 

Buccal    cavity 186             6.5  172         10.6  14             1.1 

Stomach  and  liver 1,377           48.0  878         54.1  499           40.1 

Peritoneum,  intestines  and  rectum.         442           15.4  223         13.7  219           17.6 

Female  generative   organs 406           14.2  406           32.6 

Breast 253             8.8  1           0.1  252           20.2 

Skin     67             2.3  41           2.5  26             2.1 

Other  or  not  specified   organs 467           16.4  336         20.8  131           10.6 

All  organs  and  parts 3,198         111.6  1,651       101.8  1,547         124.3 

Aside  from  locality,  the  cancer  death  rate  is  materially  modified  by 
race.  Table  18  shows  the  rate  for  the  District  of  Columbia  for  the 
decade  ending1  1910. 


TABLE    18.— MORTALITY    FROM    CANCER    IN    THE    DISTRICT    OF    COLUMBIA, 

U.   S.   A.,    1901-1910,    BY   AGE,   SEX   AND    RACE;    RATE 

PER    100,000    OF    POPULATION 

Ages 
Under    10 

10-19 

20-29 

30-39 

40-49 

50-59 

60-69 
70  and  over 

All  ages 
40  and  over 


Males 

Females 

1.7 

0.6 

4.2 

1.7 

5.8 

3.1 

23.2 

56.0 

62.5 

162.2 

182.4 

347.3 

413.7 

456.4 

610.6 

556.9 

70.6 

104.8 

217.1 

312.0 

Males 

Females 

2.7 

1.1 

9.7 

13.1 

26.3 

72.3 

48.7 

207.3 

139.6 

328.9 

310.1 

386.6 

335.1 

522.1 

38.6 

86.5 

130.2 

293.9 

It  is  shown  that  at  all  ages  of  40  and  over,  the  cancer  death  rate  of 
white  men  was  217.1,  and  of  colored  men,  130.2.  The  rates,  however, 
approach  each  other  much  more  closely  in  the  case  of  women,  it  being 
shown  that  the  cancer  death  rate  for  white  women  was  312  and  for 
colored  women  293.9.  As  an  interesting  sidelight  on  the  influence  of 
race  on  the  cancer  death  rate,  a  table  for  the  island  of  Ceylon  is 
included  (Table  19),  showing  the  cancer  mortality  for  the  different 
racial  elements  of  the  island  for  the  period  1908-1912. 


12  CANCER    STATISTICS— HOFFMAN 

TABLE    19.— MORTALITY    FROM    CANCER    BY    RACES,    CEYLON,    1908-1912 

Deaths  Rate 

Race                                              Total  from  per  100,000 

Population  Cancer  of  Population 

Europeans    37,646  6  15.9 

Burghers     131,252  34  25.9 

Sinhalese     13,245,206  962  7.3 

Tamils     5,488,143  296  5.4 

Moors    1,298,270  84  6.5 

Malays    63,082  2  3.2 

Others    85,466  7  8.2 

Total     20,349,065  1,391  6.8 

The  very  low  rate  of  6.8  for  the  island  of  Ceylon  is  almost  entirely 
due  to  cancer  of  the  buccal  cavity,  which  is  directly  attributable  to 
the  universal  habit  of  betel-nut  chewing.  Granting  that  the  cancer 
returns  for  Ceylon  are  not  of  a  high  degree  of  intrinsic  trustworthiness 
comparable  with  the  United  States  registration  area  or  European 
countries,  there  can  be  no  doubt  but  that,  in  the  main,  malignant 
disease  is  comparatively  rare,  not  only  in  Ceylon,  but  also  in  India  and 
other  parts  of  Asia. 

That  the  observed  variations  in  cancer  frequency  throughout  the 
world  are  not  primarily  determined  by  possible  errors  of  diagnosis 
or  defective  methods  of  death  registration,  is  clearly  shown  by  the 
comparative  study  of  cancer  death  rates  in  civilized  countries  according 
to  organs  and  parts  of  the  body  affected.  This  aspect  of  the  cancer 
problem  has  thus  far  received  inadequate  consideration,  but  the  data 
are  unquestionably  of  the  greatest  practical  significance  in  the  statis- 
tical study  of  cancer  occurrence.  Table  20  exhibits  the  comparative 
frequency  of  cancer  of  the  stomach,  liver  and  oesophagus  in  thirteen 
different  countries  of  the  world  for  the  period  1906-1910. 

TABLE  20.— COMPARATIVE  FREQUENCY  OF  CANCER  OF  THE  STOMACH,  LIVER 

AND    OESOPHAGUS    IN    THIRTEEN    DIFFERENT    COUNTRIES 

OF  THE  WORLD,  PERIOD   1906-1910;   RATE  PER 

100,000    OF    POPULATION 

Switzerland     70.4  England  and   Wales 31.4 

Holland    62.2  Ireland     31.0 

Norway    61.4  United   States  Registration  Area 28.3 

Bavaria    59.4  Australia    Commonwealth  t 27.4 

Japan*    40.0  Italy    26.2 

Scotland    36.0  Cuba  f    12.7 

Uruguay    35.6 

*  Period    1909-1910.         f  Period   1908-1912. 

The  international  contrast  presented  by  this  table  is  of  unusual 
interest.  It  is  shown  that  the  mortality  from  cancer  of  the  stomach, 
liver  and  oesophagus  was  relatively  higher  in  Uruguay  and  Japan,  than 
in  the  United  States  registration  area  and  England  and  Wales.  No 
defects  in  registration  or  errors  in  diagnosis  could  possibly  account  for 
such  profound  differences  in  the  specific  incidence  of  cancer  occurrence 


CANCER    STATISTICS— VARIOUS    COUNTRIES  13 

limited  to  a  thoroughly  well-understood  group  of  malignant  affections. 
Table  20  also  brings  out  the  fact  that  the  rate  for  this  group  of  cancers 
was  over  twice  as  high  in  Switzerland  and  Holland  as  in  the  United 
States  registration  area.  It  would  seem  absurd  to  maintain  in  the 
face  of  this  evidence  that  the  observed  differences  in  the  rates  of 
cancer  frequency  are  primarily  determined  by  accuracy  in  diagnosis 
or  completeness  in  methods  of  death  registration  and  analysis.  In 
other  words,  the  excess  or  deficiency  in  the  specific  cancer  death  rates 
by  organs  and  parts  of  the  body  must  be  accounted  for  by  determinable 
variations  in  local  conditions,  particularly  as  regards  the  mode  of  life, 
the  food,  the  nutrition,  etc.,  of  the  localities  or  countries  considered. 

A  similar  comparison  for  eleven  countries  is  made  of  the  mortality 
of  cancer  of  the  skin  in  Table  21. 

TABLE  21.— COMPARATIVE  FREQUENCY  OF  CANCER  OF  THE  SKIN  IN  ELEVEN 

DIFFERENT   COUNTRIES    OF  THE   WORLD,  PERIOD    1906-1910; 

RATE    PER    100,000    OF    POPULATION 

United   States  Registration  Area 2.7  Scotland    1.7 

Ireland     2.7  Holland    1.4 

Australian    Commonwealth* 2.3  Uruguay    1.1 

England   and   Wales 2.1  Bavaria    0.8 

Cuba*    2.0  Japan  f    0.7 

Switzerland     1.9 

*  Period  1908-1912.        t  Period   1909-1910. 

It  is  shown  that  Scotland,  Switzerland  and  Japan  have  distinctly 
low  rates  of  mortality  in  cancer  of  the  skin,  whereas  the  rates  are  dis- 
tinctly excessive  for  the  United  States  registration  area,  Ireland  and 
the  Australian  Commonwealth. 

Even  more  interesting  in  this  respect  are  the  wide  variations  in 
the  comparative  frequency  rates  of  cancer  of  the  female  generative 
organs.  Table  22  shows  the  rates  for  thirteen  different  countries  of 
the  world. 


TABLE    22.— COMPARATIVE    FREOUENCY    OF    CANCER    OF    THE    FEMALE    GEN- 
ERATIVE   ORGANS    IN    THIRTEEN    DIFFERENT    COUNTRIES    OF 
THE    WORLD,    PERIOD    1906-1910;    RATE    PER    100,000 
OF     FEMALE     POPULATION 

England   and  Wales 24.2         Italy    16.0 

United  States  Registration  Area 22.1         Australian    Commonwealth  f 15.5 

Bavaria     21.6         Holland    13.2 

Switzerland     21.4         Ireland    12.8 

Japan*    20.9         Uruguay    12.2 

Scotland    20.6         Norway    11.5 

Cuba  t   18.9 

♦Period  1909-1910.        t  Period  1908-1912. 

The  highest  rates  are  shown  to  prevail  in  England  and  Wales,  fol- 
lowed by  the  United  States  registration  area  and  Bavaria.    The  lowest 


14  CANCER    STATISTICS— HOFFMAN 

rates  are  for  Norway,  Uruguay  and  Ireland.  If  the  argument  were 
sound  that  a  low  cancer  death  rate  must  be  considered  evidence  of 
imperfect  diagnostic  skill  or  defective  methods  of  death  registration, 
Norway  would  rank  first  as  regards  diagnosis  of  cancer  of  the  stomach, 
liver  and  oesophagus  and  last  as  regards  diagnosis  of  cancer  of  the 
female  generative  organs.  It  would  also  follow  that  since  the  rate  for 
Scotland  was  about  the  same  as  for  Japan,  the  diagnosis  of  cancer  of. 
the  female  generative  organs  was  about  equally  well-developed  in  these 
two  countries,  though  widely  at  variance  on  the  basis  of  the  same1 
hypothesis  in  cancer  of  the  skin. 

Finally,  the  comparative  frequency  rates  for  cancer  of  the  female 
breast  are  of  special  interest,  since  this  form  of  cancer  is,  perhaps, 
the  most  accurately  diagnosed  in  the  entire  group  of  malignant  diseases. 
Table  23  shows  the  mortality  from  cancer  of  the  female  breast  in 
thirteen  different  countries  of  the  world  per  100,000  of  female 
population. 

TABLE  23.— COMPARATIVE  FREQUENCY  OF  CANCER  OF  THE  FEMALE  BREAST 

IN    THIRTEEN    DIFFERENT    COUNTRIES    OF    THE    WORLD,    PERIOD 

1906-1910;    RATE    PER    100,000    OF    FEMALE    POPULATION 

England  and   Wales 17.9         Bavaria    9.1 

Scotland    15.4        Norway    7.3 

Ireland     14.0        Italy    5.2 

Switzerland    13.6         Cuba*     4.5 

United   States  Registration  Area 13.3         Uruguay     3.7 

Australian    Commonwealth* 10.6        Japan  f    1.8 

Holland    9.6 

♦Period  1908-1912.        t  Period  1909-1910. 

! 

Recalling  that  the  mortality  from  cancer  of  the  female  generative 
organs  was  practically  the  same  in  Japan  and  Scotland,  it  is  shown 
by  Table  23  that  there  was  an  immense  disparity  in  the  relative  fre- 
quency rates  for  cancer  of  the  female  breast;  in  fact,  the  rate  for 
England  and  Wales  is  almost  exactly  ten  times  the  rate  for  Japan. 
Such  differences  as  these  are  conclusive  evidence  that  the  variations 
observed  in  crude  cancer  death  rates  are  evidently  determined  by  pro- 
found differences  in  the  specific  cancer  frequency  according  to  organs 
and  parts  of  the  body  affected.  It  is  in  this  direction  that  statistical 
research  can  be  of  most  value  to  the  cancer  cause,  for  by  determin- 
ing the  precise  differences  in  local  variations  of  incidence  according  tc 
the  seat  of  primary  growth,  it  may  be  possible  in  time  to  ascertain  thej 
contributory  conditions  or  circumstances  responsible  for  these  observed 
and  clearly  established  variations.  The  attainment  of  this  purpose! 
however,  requires  the  perfection  of  the  rules  of  statistical  practice 
the  adoption  of  standard  methods  of  tabulation  and  analysis,  the  gen' 


CANCER    STATISTICS— TENDENCY  15 

eral  use  of  the  international  classification  of  causes  of  death,  and  the 
extended  use  of  the  details  of  that  classification  by  specified  organs  or 
parts  of  the  seat  of  primary  growth.  These  brief  considerations  are 
merely  intended  to  emphasize  the  practical  utility  of  statistical  research 
in  the  furtherance  of  the  cancer  cause.  The  subject  is  of  vast  extent, 
extremely  complicated,  but  fruitful  of  useful  results. 

"  Among  important  lines  of  collateral  statistical  research  a  brief 
reference  may  be  made  to  the  study  of  precise  correlation  of  the  com- 
parative frequency  or  changes  in  frequency  occurrence  of  cancer  and 
Dther  more  or  less  allied  diseases,  such  as  benign  tumors,  biliary 
zalculi,  etc.  Furthermore,  this  line  of  inquiry  should  be  extended  to 
nclude  such  diseases  as  diabetes,  appendicitis,  rheumatism,  gout, 
syphilis,  tuberculosis,  malaria,  etc.  Most  of  the  present-day  conclu- 
sions regarding  the  correlation  of  cancer  to  any  and  all  of  these,  as 
veil  as  other,  diseases  are  based  on  a  rather  superficial  consideration 
)f  all  the  statistical  evidence  which  requires  to  be  taken  into  account. 
50  far  as  practicable,  extended  consideration  has  been  given  to  these 
nore  involved  aspects  of  the  cancer  problem  in  my  forthcoming  work 
>n  The  Mortality  from  Cancer  Throughout  the  World. 

In  its  final  analysis  the  statistical  method  is  of  the  first  order  of 
mportance  in  determining  the  tendency  of  the  cancer  death  rate.  In 
trict  conformity  to  the  law  of  large  numbers,  the  conclusions  improve 
p  accuracy  in  proportion  to  the  amount  of  data  considered.  Table  24 
[hows  the  increase  in  the  cancer  death  rate  in  the  New  England  States, 
New  York  and  New  Jersey,  combined,  for  the  period  1886-1913. 

ABLE    24.  —  MORTALITY    FROM    CANCER    IN    THE    NEW    ENGLAND     STATES, 
NEW    YORK    AND    NEW    JERSEY,    PERIOD    1886-1913 


Deaths 

Rate  per 

Years 

Population 

from 

100,000 

Index 

Cancer 

Population 

Number 

1886-1890 

55,320,449 

26,215 

47.4 

100.0 

1891-1895 

64,879,439 

34,536 

53.2 

112.2 

1896-1900 

71,405,669 

44,645 

62.5 

131.9 

1901-1905 

78,132,762 

55,501 

71.0 

149.8 

1906-1910 

87,343,060 

69,140 

79.2 

167.1 

1911 

18,699,051 

15,980 

85.5 

180.4 

1912 

18,976,968 

16,640 

87.7 

185.0 

1913 

19,327,233 

17,385 

90.0 

189.9 

It  is  shown  that  the  relative  cancer  death  rate,  assuming  the  rate 
Dr  the  period  1886-1890  as  100,  is  now  189.9,  or,  in  other  words,  there 
as  been  an  increase  in  the  cancer  death  rate  of  89.9  per  cent,  during 
te  intervening  period  of  twenty-three  years. 

A  similar  comparison  is  presented  in  Table  25,  for  twenty  large 
,..merican  cities  for  the  period  1881-1913. 


16 


CANCER    STATISTICS— HOFFMAN 


TABLE     25.  —  MORTALITY     FROM     CANCER     IN     TWENTY     LARGE    AMERICA* 
CITIES,     PERIOD     1881-1913 


Deaths 

Rate  per 

Years 

Population 

from 

100,000 

Index 

Cancer 

Population 

Number 

1881-1885 

30,328,347 

14,735 

48.6 

95.9 

1886-1890 

35,302,944 

17,884 

50.7 

100.0 

1891-1895 

40,912,510 

22,513 

55.0 

108.5 

1896-1900 

47,016,267 

28,533 

60.7 

119.7 

1901-1905 

53,386,935 

37,727 

69.5 

137.1 

1906-1910 

60,116,913 

47,701 

79.3 

156.4 

1911 

12,849,687 

10,713 

83.4 

164.5 

1912 

13,125,121 

11,203 

85.4 

168.4 

1913 

13,400,553 

11,971 

89.3 

176.1 

Assuming,  again,  the  period  1886-1890  to  be  represented  by  100,  th 
relative  rate  for  1913  was  176.1,  in  other  words,  in  the  twenty  citid 
referred  to,  during  the  last  twenty-three  years  the  cancer  death  ratj 
has  increased  76.1  per  cent. 

In  conclusion,  the  comparative  rates  are  shown  for  twenty  Ameri 
can  and  ten  large  European  cities,  in  Table  26 : 

TABLE    26.— COMPARISON    AS    TO    MORTALITY    FROM    CANCER,    IN    TWENT 
AMERICAN    AND    TEN    EUROPEAN    CITIES;    PERIOD     1881-1912 


, American  Cities ^ 

, European 

Cit 

es ^ 

Cancer  Death-Rate 

Cancer  Death-Rate 

Years 

per   100,000 

Index 

per  100,000 

Index 

Population 

Number 

Population 

Number 

1881-1885 

48.6 

100 

75.4 

100 

1886-1890 

50.7 

104 

82.0 

109 

1891-1895 

55.0 

113 

87.9 

117 

1896-1900 

60.7 

125 

97.2 

129 

1901-1905 

69.5 

143 

106.2 

141 

1906-1910 

79.3 

163 

114.4 

152 

1911 

83.4 

172 

114.7 

152 

1912 

85.4 

176 

118.3 

157 

Differen 
in  Rate 
26.8 
31.3 
32.9 
36.5 
36.7 
35.1 
31.3 
32.9 

The  evidence  presented  by  these  tables,  as  well  as  the  addition; 
information  derived  from  other  equally  trustworthy  sources,  uncoi 
ditionally  confirms  the  conclusion  that  cancer  is  relatively  on  tl 
increase  throughout  the  civilized  world,  and  that  the  increase  is  affec 
ing  practically  all  important  organs  and  parts  of  the  body,  but  chief 
for  the  age  period  of  50  and  over.  It  would  therefore  seem  entire 
appropriate  to  refer  to  the  present  situation  as  a  menace  to  civilize 
mankind,  and  to  insist  on  the  duty  of  the  heartiest  and  most  thorough 
nation-wide  cooperation  in  the  effort  to  bring  about  an  aroused  publ 
interest  in  a  subject,  than  which,  considering  the  enormous  amount 
human  suffering  and  loss  of  life,  none  can  appeal  more  powerfully 
the  sympathy  and  scientific  interest  of  the  world. 


COLUMBIA  UNIVERSITY  LIBRARIES 

This  book  is  due  on  the  date  indicated  below,  or  at  the 
expiration  of  a  definite  period  after  the  date  of  borrowing,  as 
provided  by  the  library  rules  or  by  special  arrangement  with 
the  Librarian  in  charge. 

DATE  BORROWED 

DATE   DUE 

DATE   BORROWED 

DATE    DUE 

^  1/3 

hr 

1 

/   ' 

1 

• 

?-'■- 

-- 

V 

C28(842)MSO 

CniiiffiiftK^?ITY  libraries 


H6718 


:*;•■':  f 


